1. ¹Department of Medicine, Bone Marrow Transplantation Program, and Department of Preventative Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, CO, USA
2. ²Rocky Mountain Cancer Centers, Denver, CO, USA
3. ³Clínica Universitaria de Navarra, Pamplona, Spain
4. ⁴University of Arizona Cancer Center, Tucson, AZ, USA
5. ⁵MD Anderson Cancer Center, Houston, TX, USA

Correspondence: Dr JA Gutman, Department of Medicine, University of Colorado Health Sciences Center, 4200 East Ninth Avenue, #B177, Denver, CO 80262, USA. E-mail: jonathan.gutman@uchsc.edu

Received 1 March 2005; Accepted 20 May 2005; Published online 4 July 2005.

Abstract

We report outcomes in advanced lymphoma patients (n=32) who enrolled in a trial of prospectively planned combined autologous/reduced-intensity transplantation (RIT) (n=25) or who received RIT shortly after prior autografting because of high relapse risk or progressive disease (n=7). Nine patients on the autologous/RIT transplant protocol did not proceed to planned RIT because of patient choice (n=4), disease progression (n=3), toxicity (n=1), or no adequate donor (n=1). Among the 23 other patients, RIT was started a median of 59 days (range 31–123) after autologous transplant. Fifteen patients had related donors, five patients had unrelated donors, and three patients had cord blood donors. Among all patients completing RIT, the median overall survival time was 385 days (95% CI 272–792), and the median relapse-free survival time was 157 days (95% CI 119–385). At the time of reporting, six patients (26%) remain alive and three patients (13%) remain alive without relapse. The 100-day transplant-related mortality (TRM) was 9% among all patients and was 0% among matched sibling donors. Overall TRM was 43%. Tandem transplant is feasible in advanced lymphoma with low early TRM. However, practical challenges associated with the strategy were significant and high levels of late TRM due to graft-versus-host disease and infections suggest that modifications of the procedure will be needed to improve outcomes and patient retention.